synonyms:Vertebral Compression Fracture, thoracic compression fracture cervical compression fracture
Compression Fractrue ICD-10
Compression Fractrue ICD-9
- 805.4 (Fracture of vertebral column without spinal cord injury (lumbar, closed)
Compression Fractrue Etiology / Epidemiology / Natural History
- Compressive failur fo the anterior vertbral body with preservation of the posterior body, PLL and posterior column. Minimal kyphosis, no canal compromise
Compression Fractrue Anatomy
Compression Fractrue Clinical Evaluation
- Palpate entire spine for tenderness / step off.
- Complete neuro exam: motor strength, pin-prick sensation, reflexes, cranial nerves, rectal examination (perineal pin-prick sensation, sphincter tone, volitional spincter control)
- Absence of the bulbocaverosus reflex indicates spinal shock. Level of spinal injury can not be determined until bulbocaverosus reflex has returned.
- See ASIA form.
Compression Fractrue Xray / Diagnositc Tests
Compression Fractrue Classification / Treatment
- Less than 50% height loss: thoracolumbrosacral (TLSO) orthosis or Jewett extension brace for 6-12 weeks
- Acute Injury (<5days); neurologically intact: Calcitonin x 4 weeks; Consider ibandronate and strontium ranelate; bed rest, opiods, bracing, supervised or unsupervised exercise, electrical stimulation. Vertebroplasty is not recommended. May considerd kyphoplasty. (AAOS guideline)
- Acute injury (<5 days; not neurologically intact: no specific treatment recommendation available.
- Cervical: anterior vertibral compression with preservation of the posterior body, PLL and posterior column. Generally stable
-Treatment = orthosis x 6-12 weeks.
- Thoracolumbar TLICSS <3: short period bedrest followed by mobilization in TLSO ro Risser-like body cast with spine in hyperextension for 10-12 weeks.
- Thoracolumbar TLICSS <5: surgery
- Vertebral boding stenting has not shown any beneficial effect compared to balloon kyphoplasty in osteoporotic vertebral fractures with regard to kyphotic correction, cement leakage, radiation exposure time, or neurologic sequelae. (Werner CM, JBJS 2013;95A:577)
- Percutaneous Vertebroplasty: Currenty not recommeded by AAOS clinical practice guidelines for the treatment of osteoporotic spinal compression fractures. Prior studies demonstrated immediate, significant and lasting reduction in back pain, and overall improvement in physical and mental health. (Muijs JBJS 2009;91B:379). Kyphoplasty appears to be associated with longer patient survival as compared to nonoperative treatment. (Chen AT, JBJS 2013;95A;1729).
- 16% of osteoporotic women with vertebral fractures with have new vertebral fractures within 2 years. Teriparatide (20-40 ug SQ QD) and Raloxifene (60-120mg PO QD) decrease new vertebral fracture risks by @70% and @50% respectively. (Bouxsein ML, JBJS 2009;91A:1329). Also should be taking Calcium 500-1000mg QD and Vitamin D 400-1200 IU QD.
Compression Fractrue Associated Injuries / Differential Diagnosis
- See Cervical Spine Trauma Differential Diagnosis.
Compression Fractrue Complications
Compression Fractrue Follow-up Care
- PT started when tolerated.
- Patients with minimal compression and no neuro involvement may return to sports when they are painfree and full strength and flexibility.
Compression Fractrue Review References